Medicare coverage of mammogram screenings

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Mammograms can detect abnormal tissue and breast cancer. If you have Original Medicare, you will not pay a coinsurance or deductible for a screening mammogram if you see doctors who take assignment. Doctors and other health care providers who take assignment cannot charge you more than the Medicare approved amount.

If a person has no symptoms or prior history of breast cancer, Medicare will cover preventive mammograms. Medicare covers:

  • One baseline mammogram for women 35 to 39 years of age
  • One screening mammogram every 12 months for women ages 40 and over

Medicare will also pay for both men and women to have diagnostic mammograms more frequently than once a year. A diagnostic mammogram may be recommended when a screening mammogram shows an abnormality or when a physical exam reveals a lump. Medicare covers as many diagnostic mammograms as necessary. These mammograms are billed differently than preventive screening mammograms. There is a 20 percent coinsurance for people with Medicare who have already met the Part B deductible.

Medicare Advantage (MA) plans cover all preventive services the same as Original Medicare. This means MA plans will not be allowed to charge cost-sharing fees (coinsurances, copays or deductibles) for preventive services that Original Medicare does not charge for as long as you see in-network providers. If you see providers that are not in your plan’s network, charges will typically apply.

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